Royal United Hospital Bath NHS Trust (JC, CG, EJ), Swansea Bay University Health Board NHS Trust (AS), Bath, UK.
Urolithiasis. 2024 Feb 1;52(1):29. doi: 10.1007/s00240-023-01523-6.
There is no clear guidance on the efficacy of stone follow-up. NICE have been unable to make recommendations with current published evidence. The aim of this study was to understand the patient journey resulting in surgical intervention, and whether traditional stone follow-up is effective. A retrospective review of patients undergoing ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) over a 3 year period identified 471 patients who underwent these procedures to treat stone disease. Records were interrogated for the following: symptoms, mechanism of booking, reason for intervention, stone size, stone location, risk factors and previous follow-up. Of 471 patients who underwent intervention, 168 were booked from stone clinic follow-up (36%). Of these, 96% were symptomatic and 4% were asymptomatic. When risk factors were removed, this figure was reduced to 1%. Sepsis rate for emergency admissions differs between those followed up (13%) versus new presentations (19)%. There was no statistically significant difference in the outpatient imaging frequency between patients booked from an emergency admission (80% having imaging every 6 months) and those from the clinic (82%). Our Hospital provides on average 650 stone clinic appointments a year with a cost of £93,000. Given the low rate of intervention in patients with asymptomatic renal stones, a symptomatic, direct-access emergency stone clinic could be a better model of care and use of NHS resources. Urgent research is required in this area to further assess if this is the case.
关于结石随访的疗效尚无明确指导。NICE 无法根据现有已发表的证据提出建议。本研究旨在了解导致手术干预的患者就诊过程，以及传统的结石随访是否有效。对过去 3 年接受输尿管镜检查 (URS) 或经皮肾镜取石术 (PCNL) 的患者进行回顾性研究，共发现 471 名接受这些手术治疗结石病的患者。记录中调查了以下内容：症状、预约机制、干预原因、结石大小、结石位置、危险因素和之前的随访情况。在接受干预的 471 名患者中，有 168 名（36%）是从结石门诊随访中预约的。其中，96%有症状，4%无症状。当去除危险因素后，这一数字降至 1%。因败血症而急诊入院的患者与新发病例（19%）相比，其接受随访的患者（13%）的入院率不同。从急诊就诊（80%的患者每 6 个月进行一次影像学检查）和从门诊（82%）预约的患者之间的门诊影像学检查频率没有统计学上的显著差异。我们医院每年平均提供 650 次结石门诊预约，费用为 93000 英镑。鉴于无症状肾结石患者的干预率较低，因此，一个以症状为导向的、直接进入的紧急结石门诊可能是一种更好的护理模式，并且能更好地利用 NHS 资源。在这一领域急需开展紧急研究，以进一步评估这种情况是否属实。
